D Decriminalized Notes: · Reflects law of states and territories, including laws which have not yet gone into effect. Does not reflect federal, tribal, or local laws. · Map does not show state legality of hemp-derived cannabinoids such as CBD or delta-8-THC, which have been legal at federal level since enactment of the 2018 Farm Bill.
In the United States, the use of cannabis for medical purposes is legal in 29 states, plus the territories of Guam and Puerto Rico, and the District of Columbia, as of April 2017.[1][2] Several other states have more restrictive laws permitting the use of cannabidiol (CBD) oil only, with limitations imposed on THC content.[1] There is considerable variation in medical cannabis laws from state to state, including how it is produced / distributed, how it can be consumed, and what medical conditions it can be used for.[3]
The first state to effectively legalize medical cannabis was California in 1996, when voters approved Proposition 215 by a 56–44 margin. Several states followed with successful ballot initiatives in 1998, and in 2000 Hawaii became the first state to legalize by state legislature.[4] In recent years, medical cannabis has spread to the Southern United States, as Florida, Arkansas, and West Virginia have all approved its use.
At the federal level, cannabis remains a prohibited substance by way of the Controlled Substances Act of 1970. Under the CSA, the Drug Enforcement Administration classifies cannabis as a Schedule I drug, determined to have a high potential for abuse and no accepted medical use – thus prohibiting its use for any purpose. The Justice Department has enforced this policy through various means, including criminal prosecutions, civil asset forfeiture, and paramilitary-style raids targeting medical cannabis providers, as well as civil and criminal penalties threatened / initiated against various other parties involved in state-legal medical cannabis activities (doctors, landlords, state officials / employees).[5] In December 2014, however, the Rohrabacher–Farr amendment was signed into law, prohibiting the Justice Department from spending funds to interfere with the implementation of state medical cannabis laws.[6]
Public support for allowing the medical use of cannabis has remained strong since Gallup first polled the subject in 1999, finding 73% in favor.[7] A February 2017 Quinnipiac poll found national support at 93%.[8]
Early medical use in the U.S.
The medical use of cannabis dates back thousands of years, to ancient China, India, and Egypt.[4] It was popularized in Western medicine by the Irish physician William Brooke O'Shaughnessy, who was introduced to the drug in the 1830's while living abroad in India.[9] O'Shaughnessy found a number of medical applications for cannabis from the experiments he conducted, noting in particular its analgesic and anticonvulsant effects.[10] He returned to England with a supply of cannabis in 1842, after which its use as medicine quickly spread throughout Europe and the United States.[11]
By the early 20th century, the use of cannabis in medicine had declined due to a number of factors, including difficulty in controlling dosages and the rise in popularity of synthetic and opium-derived drugs.[11] The advent of the hypodermic syringe also allowed these drugs to be injected for immediate effect, in contrast to cannabis which is not water-soluble and thus cannot be injected.[12] Additionally, as fears regarding the recreational use of cannabis began to take hold (prompted by sensationalist media reports and government propaganda campaigns),[10] states began passing legislation to restrict the sale and possession of cannabis, eliminating its availability as an over-the-counter drug.[13] By 1936, every state had passed a law of this manner.[10]
The use of cannabis as medicine further declined with the passage of the Marihuana Tax Act of 1937. The purpose of the act was to prohibit all non-medical use of cannabis in the United States; however, it also had the effect of severely curtailing medical use of the drug, due to new fees and regulatory requirements put in place that imposed a significant burden on doctors prescribing cannabis.[13] For this reason the American Medical Association opposed the Marihuana Tax Act of 1937, but to no avail.[13] Cannabis was removed from the United States Pharmacopeia in 1941, at the urging of famed anti-cannabis crusader Harry Anslinger.[12]
During the 1960's, as large numbers of people began to use cannabis recreationally, the medical utility of cannabis was rediscovered by some as anecdotes began to appear about its effectiveness in treating a variety of medical conditions.[11] It was officially banned for even medical use, however, following the passage of the Controlled Substances Act in 1970. Despite the strict federal prohibition in place, cannabis continued to gain renewed interest as medicine in the 1970's and 1980's, in particular due to the testimonials of cancer and AIDS patients who reported significant relief from the debilitating symptoms of wasting syndrome.[14] The smoking method of consumption – popularized by recreational users of the drug – offered particular aid to patients who had trouble keeping down oral medication (without vomiting), and also offered advantages in terms of rapid onset of action and the ability to more carefully control dosages.[3]
Federal policy
Controlled Substances Act
On October 27, 1970, the Comprehensive Drug Abuse Prevention and Control Act of 1970 was signed into law by President Richard Nixon. Title II of the act – the Controlled Substances Act – established a system under which all controlled substances are categorized, varying from Schedule I (the strictest classification) to Schedule V (the least strict). Cannabis was placed in the Schedule I category, assumed to have a high potential for abuse and no accepted medical use – thus prohibiting its use for any purpose.[15] This placement was intended only as a temporary measure, however, pending the results of a commission formed under decree of the CSA to study the dangers of cannabis.[12] Formally known as the National Commission on Marihuana and Drug Abuse, the Shafer Commission – led by former Pennsylvania governor Raymond P. Shafer – determined in its March 1972 report to the President and Congress that the societal harms caused by cannabis were limited, and recommended removal of criminal penalties for possession and distribution of small amounts of the drug.[16] Although the report did not specifically address the scheduling of cannabis,[17] it did not contain any findings that supported continued placement in the Schedule I category, and members of the commission acknowledged that cannabis did not meet the Schedule I criteria.[18] This was of no consequence, however, as President Nixon strongly denounced the work of the commission, and no action was taken to move cannabis into a less restrictive category.[16] The Schedule I classification of cannabis remains in place today, alongside other drugs such as heroin, ecstacy, DMT, LSD, and peyote – none of which can be prescribed. Schedule II drugs – determined to have a high potential for abuse but also some accepted medical use (thus able to be prescribed) – include cocaine, PCP, methamphetamine, oxycodone, and fentanyl.[19][20]
Rescheduling efforts
Since enactment of the Controlled Substances Act in 1970, there have been a number of efforts seeking to have cannabis placed into a less restrictive category, but none have succeeded. The Drug Enforcement Administration is granted authority under the CSA to change the classification of any drug, based upon the recommendation of the Food and Drug Administration which evaluates all drugs for safety and efficacy.[3] As recently as 2016 the DEA / FDA have determined that cannabis has "no currently accepted medical use in treatment in the United States", in response to a rescheduling petition filed in 2011 by the governors of Washington and Rhode Island.[21] Other petition efforts have also been unsuccessful, spanning the years 1972–1994, 1995–2001, and 2002–2013.[22][23] Congressional attempts to reschedule cannabis have failed as well, including a 1981 bill introduced by Reps. Stewart McKinney and Newt Gingrich that grew to 100 cosponsors but never received the necessary hearings for a floor vote.[12]
The classification of cannabis as a Schedule I drug was first challenged by the National Organization for the Reform of Marijuana Laws (NORML) in a 1972 petition to the Drug Enforcement Administration (known at the time as the Bureau of Narcotics and Dangerous Drugs).[24] After a decade of legal battles in which the DEA refused to consider the petition, public hearings were finally held on the matter beginning in 1986.[25] In September 1988, after two years of extensive public hearings,[11] the DEA's chief administrative law judge Francis L. Young ruled in favor of moving cannabis to a Schedule II classification, stating that "Marijuana, in its natural form, is one of the safest therapeutically active substances known to man" and "The evidence in this record clearly shows that marijuana has been accepted as capable of relieving the distress of great numbers of very ill people, and doing so with safety under medical supervision. It would be unreasonable, arbitrary and capricious for DEA to continue to stand between those sufferers and the benefits of this substance in light of the evidence in this record."[15] In December 1989 however, DEA Administrator John Lawn overruled Judge Young's determination,[12] and in February 1994 a final ruling on the original 1972 petition was issued when a U.S. Court of Appeals upheld the decision to keep cannabis a Schedule I drug.[13]
Compassionate IND program
Despite an official policy denying the medical value of cannabis, the federal government began providing the drug to a limited number of patients through the Compassionate Investigational New Drug program in 1978. The program was created following a lawsuit filed by Robert Randall, a Washington, D.C. resident who was arrested for cultivating cannabis in 1975.[26] Citing the glaucoma that threatened to take his eyesight, Randall employed a "medical necessity" defense at trial to justify his use of cannabis.[26] The charges against Randall were dismissed, and as a result of an ensuing petition filed with the FDA, Randall became the first person to receive cannabis from the federal government in 1976.[26] After his supply was cut off in 1978, he filed a lawsuit to have it restored,[26] setting in motion the creation of the Compassionate Investigational New Drug program shortly thereafter.[27] The program allowed patients with serious medical conditions to receive a regular supply of cannabis from the federal government; however, only 13 patients ended up participating due to the very complicated and drawn-out application process involved.[11]
The Compassionate IND program was closed to new patients in 1992, due to a flood of new applications from AIDS patients and concerns that the program undercut Bush administration efforts to combat illegal drug use.[28] The head of U.S. Public Health Service, James O. Mason, explained that keeping the program in place invited the "perception that this stuff can't be so bad", and noted that AIDS patients provided with cannabis would be more likely to engage in unsafe sex.[29] Twenty-eight applications that had recently been approved were rescinded, and only the 13 patients who were already receiving cannabis were allowed to do so moving forward.[11] As of 2016, most of the original 13 patients had perished but at least two were known to be still receiving cannabis from the federal government.[30]
Federal enforcement
Clinton administration
Concurrent with the re-election of President Bill Clinton in November 1996, California voters approved Proposition 215 to legalize the medical use of cannabis, and a similar (but ultimately ineffective) measure was passed in Arizona. In response, the Clinton administration threatened to criminally prosecute doctors who prescribe or recommend cannabis, as well as revoke doctors' licenses for the prescription of controlled substances and block participation in Medicare and Medicaid.[31] A group of physicians challenged this policy as a violation of First Amendment rights, and in September 2000 prevailed in the case Conant v. McCaffrey, which upheld the right of physicians to recommend (but not prescribe) cannabis.[3] In addition to threats leveled against physicians, the administration conducted armed raids on a number of medical cannabis facilities, and initiated civil and criminal legal actions against patients and providers.[5] At trial, defendants were prohibited from informing juries that they were acting in accordance with state medical cannabis laws, thus giving the federal government a significant advantage in carrying out prosecutions.[5] Drug czar Barry McCaffrey also railed strongly against the medical use of cannabis – deriding it as "Cheech & Chong medicine" – and worked behind closed doors to coordinate a media campaign to sway public opinion against approving further medical cannabis initiatives.[32]
Bush administration
Despite speaking in support of states' rights on the issue during his 2000 presidential campaign,[33]President George W. Bush intensified the federal crackdown on medical cannabis during his 8 years in office, with more than 260 raids conducted and 84 individuals prosecuted by his administration.[5] Heavy use of paramilitary tactics / gear was common in execution of the raids, along with the frequent use of civil forfeiture, allowing cash and property to be seized without need for a criminal conviction.[5] In 2007, the administration began targeting landlords renting to medical cannabis facilities, informing property owners that they faced up to 20 years in prison for violating the "crack house statute" of the CSA, in addition to seizure of their properties.[15] Bush's drug czar, John P. Walters, was particularly opposed to the medical use of cannabis, campaigning against initiatives in a number of states in what medical cannabis advocates charged was an inappropriate use of taxpayer dollars and a violation of the Hatch Act.[34] During Bush's 2nd term, in June 2005, the Supreme Court ruled in favor of the federal government's ability to enforce federal law in states that have legalized medical cannabis, in the case Raich v. Gonzalez.[3]
Obama administration
The presidency of Barack Obama was noted for a strong federal crackdown on medical cannabis during his first term in office, despite early indications that his administration would take a more relaxed approach. During his 2008 campaign for president, Obama expressed support for allowing states to implement their own medical cannabis policies, stating "I'm not going to be using Justice Department resources to try to circumvent state laws on this issue."[35] These comments were then echoed by the administration in March 2009 when Attorney General Eric Holder stated that only medical cannabis providers "who violate both federal and state law" would be targeted for prosecution.[36] Additionally, an October 2009 memo from Deputy Attorney General David Ogden laid out further guidelines for federal enforcement while also largely affirming the earlier-stated hands-off approach for state-legal medical cannabis activities.[36] Despite these public indications of lessened enforcement from the Obama administration, however, an increasing number of raids were conducted on medical cannabis facilities throughout Obama's first two years in office, surpassing even the Bush administration in frequency.[35]
"Cannabis is Medicine, Let States Regulate!" protest in San Francisco, April 4, 2012
Federal enforcement efforts against medical cannabis were further intensified in early 2011 (shortly after Michele Leonhart was confirmed as DEA Administrator),[36] as U.S. Attorneys began sending out letters to state officials and employees in several states, threatening criminal prosecution for implementing new laws regulating the distribution of medical cannabis.[5] Some letters even threatened seizure of state buildings used to conduct activities such as the processing of medical cannabis licenses.[37] In response to requests for clarification from numerous elected officials, a new memo was issued by Deputy Attorney General James M. Cole in June 2011 setting forth the conditions under which federal law would be enforced.[35] The Cole memo asserted that recent actions taken were actually consistent with the 2009 Ogden memo, and that the Ogden memo protections only applied to individuals and not commercial operations.[37] As the federal raids continued following release of the memo, U.S. Attorneys began sending out hundreds of letters over the next two years threatening civil asset forfeiture and criminal prosecution for landlords who were renting their properties to dispensaries and cultivation facilities.[5] By June 2013, the total amount spent from the Obama administration's crackdown on medical cannabis had climbed to $289 million, surpassing the previous 8 years of the Bush administration by $100 million.[5] And the number of raids conducted during Obama's first 4 1/2 years had reached 270, in contrast to 260 during Bush's 8 years.[5]
Early in President Obama's 2nd term, in August 2013, the Justice Department issued a new "Cole memo" setting forth the conditions under which federal cannabis law would be enforced. The memo was prompted in particular by the recent legalization of non-medical cannabis in Washington and Colorado, but also addressed enforcement in medical cannabis states.[37] Regarding the medical use of cannabis, the memo was considered to take a significantly more relaxed approach (compared to the June 2011 memo), similar in nature as to the how 2009 Ogden memo was originally interpreted.[37] Federal enforcement was further scaled back with the enactment of the Rohrabacher–Farr amendment in December 2014, although the Justice Department initially continued with a number of prosecutions until a pair of court rulings determined it was interpreting the amendment incorrectly.
Rohrabacher–Farr amendment
On December 16, 2014, a landmark victory was achieved for medical cannabis at the federal level with the signing into law of the Rohrabacher–Farr amendment. Initially introduced by Reps. Maurice Hinchey, Dana Rohrabacher, and Sam Farr in 2003, the amendment prohibits the Justice Department from spending funds to interfere with the implementation of state medical cannabis laws. It failed by a vote of 152–273 upon its initial introduction in 2003, and was defeated five more times over the next decade until it passed the House by a 219–189 vote on May 30, 2014, as an attachment to the CJS Appropriations bill for fiscal year 2015.[38] It did not receive a vote in the Senate, but was inserted (without a vote) into the $1.1 trillion "cromnibus" spending bill during final negotiations, which became law with President Obama's signature on December 16, 2014.[39] The Rohrabacher–Farr amendment passed the House by an even larger margin (242–186) in June 2015,[40] then won approval in a 21–9 Senate Appropriations Committee vote,[41] and was signed into law as part of the FY 2016 omnibus appropriations bill on December 18, 2015.[42] The amendment was subsequently included in a series of spending bills approved in 2016 and 2017, with the most recent extension expiring on September 30, 2017.[43]
Although the Rohrabacher–Farr amendment offers important protections for state-legal medical cannabis activities, it does not change the legal status of cannabis, and must be renewed each fiscal year in order to remain in effect.[6] The Justice Department has also interpreted the amendment in a manner vastly different from the authors' intent, which it has used to justify a number of raids after the law's enactment.[44] U.S. District Judge Charles Breyer ruled against the Justice Department in October 2015, however, stating that the DOJ interpretation "defies language and logic" and "tortures the plain meaning of the statute", and was "counterintuitive and opportunistic".[45] The Ninth Circuit Court of Appeals similarly rejected the DOJ's arguments in an August 2016 ruling.[46]
State policy
Early laws (late 1970's through 80's)
Due to increasing public awareness of the medical benefits of cannabis, and in anticipation of forthcoming changes to federal policy, a number of states passed laws addressing the medical use of cannabis in the late 1970's and early 1980's.[13]New Mexico was the first to do so in 1978, and by the end of 1982 over thirty states had followed suit.[47] The majority of these laws sought to provide cannabis through federally-approved research programs administered by the states, using cannabis supplied by the National Institute of Drug Abuse. Only seven states ended up implementing the programs however,[3] due to the large bureaucratic and regulatory obstacles imposed by the federal government.[11] Other states passed laws allowing doctors to prescribe cannabis, or reclassifying cannabis in a state's internal drug scheduling system. These laws were largely ineffectual though, due to the continued prohibition of medical cannabis at the federal level.[3] A few states passed laws establishing the ability to use a "medical necessity" defense at trial.[13] By the mid-80's, however, efforts to pass new medical cannabis laws had ground to a halt, and a number of existing laws were either repealed or allowed to expire.[13]
California (early and mid-1990's)
Beginning in the early 1990's in the state of California, medical cannabis advocates began to gain ground with a series of legislative achievements at the state and local level. In 1991, 79% of San Francisco voters approved Proposition P, which called on state lawmakers to pass legislation allowing for the medical use of cannabis.[12] Additionally, the city board of supervisors passed a resolution in August 1992 urging the police commission and district attorney to "make lowest priority the arrest or prosecution of those involved in the possession or cultivation of [cannabis] for medicinal purposes" and to "allow a letter from a treating physician to be used as prima facia evidence that marijuana can alleviate the pain and suffering of that patient's medical condition".[48] The resolution allowed the open distribution of cannabis to AIDS patients and others throughout the city, most notably through the San Francisco Cannabis Buyers Club which was operated by medical cannabis activist Dennis Peron (who spearheaded Proposition P and later the statewide Proposition 215).[49] Similar clubs appeared outside San Francisco in the ensuing years as other cities passed legislation to support the medical use of cannabis. The Wo/Men's Alliance for Medical Marijuana was founded in 1993 after 75% of Santa Cruz voters approved Measure A in November 1992.[50] And the Oakland Cannabis Buyers' Cooperative was founded in 1995 shortly before the city council passed multiple medical cannabis resolutions.[50]
Following the lead of San Francisco and other cities in California, state lawmakers passed Senate Joint Resolution 8 in 1993, a non-binding measure calling on the federal government to allow physicians to prescribe cannabis for medical purposes.[29] Legislators then approved Senate Bill 1364 in 1994, seeking to reclassify cannabis as a Schedule II drug at the state level.[29] And Assembly Bill 1529 was approved in 1995, to create a "medical necessity" defense for patients with a physician's recommendation for cannabis, for treatment of AIDS, cancer, glaucoma, or multiple sclerosis.[29] Both SB 1364 and AB 1529 were vetoed by Governor Pete Wilson, however, paving the way for the passage of Proposition 215 in 1996.[29]
Modern laws (1996 to present)
Frustrated by vetoes of medical cannabis bills in successive years, medical cannabis advocates took the issue directly to the voters of California by collecting 775,000 signatures for qualification of a ballot initiative in 1996.[51]Proposition 215 – the Compassionate Use Act of 1996 – was subsequently approved with 56% of the vote, legalizing the use, possession, and cultivation of cannabis with a physician's recommendation for the treatment of cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, or "any other illness for which marijuana provides relief".[52] The law also asked state legislators to "implement a plan to provide for the safe and affordable distribution of marijuana" to patients, which was addressed several years later with the passage of Senate Bill 420.[53]
Also in 1996, 65% of Arizona voters approved Proposition 200, a drug policy reform initiative containing a provision allowing the use of cannabis with a doctor's prescription.[54] The medical cannabis portion of the initiative was then essentially repealed by state legislators a few months later,[55] but the change was rejected by Arizona voters in a 1998 veto referendum.[56] Ultimately the medical cannabis provision was ineffective, however, due to language that created significant conflict with federal law (use of the word "prescribe" instead of "recommend").[3]
In 1998, medical cannabis initiatives were voted on in the states of Washington, Oregon, Alaska, and Nevada – all of which passed.[15] Also, in Washington, D.C., Initiative 59 to legalize the medical use of cannabis passed with 69% of the vote, but a series of amendments introduced by Rep. Bob Barr and approved by Congress prevented its implementation for over a decade.[57] The initial Barr amendment was enacted prior to the November 1998 election but after ballots had been printed, thus allowing D.C. voters to vote on the initiative but preventing the results from being made public.[58] The amendment was challenged in court by the American Civil Liberties Union on grounds that it violated First Amendment rights, and in September 1999 U.S. District Court Judge Richard W. Roberts agreed, overturning the Barr amendment.[59] Rep. Barr then introduced a similar amendment which became law in November 1999, setting off a long legal battle[60] until finally in December 2009 the Barr amendment was removed from the annual D.C. appropriations bill, allowing the original 1998 ballot initiative to move forward.[57]
Following the approval of several ballot measures in 1998, Maine voters passed a medical cannabis initiative in 1999 that was expanded by both the state legislature and another ballot initiative in subsequent years.[3] In 2000, medical cannabis initiatives were passed in the states of Colorado and Nevada, with Nevada's initiative passing for a 2nd consecutive election as required to amend the state's constitution.[61] Also in 2000, Hawaii became the first state to legalize medical cannabis by state legislature.[15]
According to various organizations tracking cannabis policy in the U.S., 29 states are considered to have passed effective medical cannabis laws, as of April 2017.[1][65][66] Additionally, Louisiana passed a medical cannabis law by state legislature in 2015 (with further revisions in 2016), but these organizations do not currently classify Louisiana among the 29 states, due to significant conflicts with federal law that have prevented full implementation of the state law,[3] as well as restrictions put in place on methods of consumption and THC content.[1]NORML does consider Louisiana to be one of 30 medical cannabis states, however.[67][68]
Low-THC / high-CBD laws
In addition to the states that have passed comprehensive medical cannabis laws, a number of states have passed more restrictive laws that do not allow the use of products exceeding a specified concentration of tetrahydrocannabinol (THC), the main psychoactive component of cannabis. The purpose of these laws is to allow the use of products containing high levels of cannabidiol (CBD), a non-psychoactive component of cannabis that has been shown to be effective for treatment of seizure / epilepsy disorders, particularly in children.[69] The use of CBD oil to treat seizure disorders gained increased attention with a number of media reports in 2012 and 2013, and by 2014 a number of states had enacted legislation to allow for the use of such products.[3] According to the National Conference of State Legislatures, 17 states are considered to have passed low-THC / high-CBD medical cannabis laws.[1]
Research
As a Schedule I drug in the United States, clinical research on cannabis must be approved by the Food and Drug Administration and a license must be obtained from the Drug Enforcement Administration specific to conducting research on Schedule I drugs. The petition to the FDA is submitted in the form of an Investigational New Drug application,[23] which the FDA has 30 days to respond to.[70] DEA licenses for research are issued for Schedules I and Schedule II–V drugs,[23] with the Schedule I license mandating stricter compliance requirements such as the manner in which substances are stored and secured.[71] The DEA review process can take up to a year.[71]
In addition to FDA approval and DEA registration, other requirements have been imposed for cannabis research in the U.S. that do not exist for any other drug, which has significantly limited the amount of research conducted. One such requirement was established in 1999 when it was mandated that all proposed research be submitted to the U.S. Public Health Service for approval.[70] This rule had an especially hindering effect as there was no timeline in which the PHS was required to respond, with some reviews taking years to complete.[70] In June 2015, however, the PHS review was eliminated to streamline the process for approving medical cannabis research.[72]
Clinical research on cannabis also requires approval from the National Institute on Drug Abuse, which is the sole provider of cannabis for research purposes in the United States. Without the NIDA approving a study and agreeing to supply cannabis, research cannot be carried out as long as there is not another source licensed by the federal government – a circumstances that has presented a significant barrier to cannabis research in the United States.[70] Compounding the problem is that the NIDA's stated mission is to support research on the causes, consequences, prevention, and treatment of drug abuse and drug addiction, and not the medicinal uses of drugs.[73] As a result, many studies on the therapeutic benefits of cannabis are either denied or altered to comply with the limited scope and mission of the NIDA.[70] There is also no timeline in which the NIDA is required to respond to proposals (as with the PHS review), which has resulted in delays ranging from months to years.[22] Additionally, the cannabis provided by the NIDA has been criticized as being inferior to that which is commonly used by medical cannabis patients in states where it is legal.[22] Criticisms of NIDA-supplied cannabis include high amounts of stems and seeds,[4] high mold and yeast levels,[74] low THC content,[22] and low diversity of strains available.[75]
NIDA monopoly
Since the agency's inception in 1974, the NIDA has been the sole provider of cannabis for research purposes in the U.S., contracting with the University of Mississippi for cultivation of the cannabis.[22] The monopoly has been maintained by the refusal of the Drug Enforcement Administration to issue another license for distribution / cultivation of the cannabis, which the DEA has claimed is consistent with the terms of the U.N. Single Convention on Narcotic Drugs that was ratified in 1961.[70] Others have disputed this interpretation of the treaty however (including the U.S. State Department),[76] and the DEA's interpretation is not consistent with the fact that multiple licenses have been issued for the production of other Schedule I drugs.[23] The DEA has also cited the possibility of diversion from cultivation facilities as a justification for not issuing additional licenses.[70]
Craker application
Critics of the NIDA monopoly have pointed to the case of University of Massachusetts Amherst professor Lyle Craker as an example of the DEA's undue resistance to granting additional licenses. Professor Craker submitted an application to the DEA in June 2001, for licensing of a cultivation facility to support FDA-approved cannabis research.[22] The DEA later claimed the application was lost, so a photocopy was resubmitted. The copy was then rejected in February 2002 because it didn't have an original signature.[22] In July 2002, the original application was returned to Professor Craker unprocessed, with a date stamp showing it had been received in June 2001. The application was then resubmitted in August 2002, upon which the DEA confirmed receipt.[22] On July 24, 2003, a notice regarding Craker’s application was filed in the Federal Register, with a public comment period ending on September 23, 2003.[22] In October 2003, U.S. Senators from Massachusetts John Kerry and Ted Kennedy wrote a letter to DEA Administrator Karen Tandy in support of granting Professor Craker a license.[22] On December 10, 2004, however, following a lawsuit filed over unreasonable delay in responding to the application, the DEA rejected Craker's application.[22] Professor Craker then filed another lawsuit in response to rejection of the application, and also requested a hearing on the matter from a DEA Administrative Law Judge, which was granted.[22] On February 12, 2007, after extensive public testimony and evidence-gathering on the subject, DEA Administrative Law Judge Ellen Bittner issued an 87-page opinion in favor of granting Professor Craker a license.[22] Additionally, in September 2007, 45 members of Congress wrote to DEA Administrator Karen Tandy urging her to approve the application in accordance with Judge Bittner's ruling.[22] Almost two years later, however, on January 9, 2009, Acting DEA Administrator Michele Leonhart overruled Judge Bittner's determination and declined to issue a license.[70] In February 2009, 16 members of Congress wrote to Attorney General Eric Holder asking him to withdraw the ruling, but to no avail.[70] The ruling was upheld by Leonhart in an August 2011 decision,[4] and again by the First Circuit Court of Appeals in April 2013.[22]
August 2016 announcement
On August 11, 2016, the DEA announced intention to issue additional licenses for the cultivation of research-grade cannabis, which would end the decades-long monopoly held by the NIDA and University of Mississippi.[77][78] As of March 2017, however, 16 organizations had submitted applications and none had been approved, with no timeline given by the DEA for the approval of any licenses.[74]
The National Conference of State Legislatures, a group representing state legislators from across the country, passed a resolution at their August 2016 annual summit calling for cannabis to be removed from the list of Schedule I drugs.[86] The U.S. Conference of Mayors similarly passed a resolution in June 2013 calling for the Controlled Substances Act to be amended to allow states to implement their own cannabis policies.[87]
Delegates at the July 2016 Democratic National Convention voted to approve a party platform calling for cannabis to be removed from the list of Schedule I drugs, as well as calling for a "reasoned pathway for future legalization".[88]
Individuals
Medical cannabis supporters demonstrate in Los Angeles (August 2007)
Eugene Monroe, Jim McMahon, Jake Plummer, and Kyle Turley are among a group of former NFL players that have advocated for allowing the use of cannabis in the league, as a treatment option for concussions and a pain reliever that can reduce reliance on addictive opioid drugs.[102][103][104]NBA head coach Steve Kerr has also voiced his support for the use of medical cannabis in professional sports.[105]
Dr. Sanjay Gupta, neurosurgeon and chief medical correspondent for CNN, has produced a three-part documentary series for the network – titled "Weed" – arguing in favor of the medical benefits of cannabis.[106] Gupta was initially dismissive toward the medical use of cannabis, but upon researching further he changed his mind and wrote a column apologizing for his past views.[107] Filmmaker Jed Riffe has also explored the subject in his 2006 documentary "Waiting to Inhale".[108]
Former U.S. Rep. Bob Barr was a particularly ardent opponent of medical cannabis in Congress, introducing the "Barr amendment" which overturned the results of a 1998 Washington, D.C. ballot initiative legalizing the medical use of cannabis.[118] After leaving Congress, however, Barr rescinded his earlier views[119] and joined Marijuana Policy Project to lobby for repeal of the legislation he originally authored.[120]
Cannabinoid drugs
There are currently two cannabinoid drugs that can be legally prescribed in the United States, and a third expected to commence sales in 2017. The non-psychoactive drug cannabidiol is also sold by a number of online retailers, although the legality is unclear.
Dronabinol
Dronabinol is THC that has been manufactured synthetically in a laboratory, as opposed to being extracted from the cannabis plant.[121] It has been approved by the FDA in pill form as Marinol and in oral solution form as Syndros.
Marinol
Marinol is a sesame oil suspension of dronabinol encapsulated in a gelatin shell.[3] It received FDA approval in 1985 for the treatment of nausea and vomiting associated with chemotherapy, and additionally in 1992 as an appetite stimulant for the treatment of AIDS-related weight loss.[11] Marinol was classified as a Schedule II drug upon its initial introduction, and was moved to Schedule III in 1999.[15] Marinol was developed by Unimed Pharmaceuticals, although initial research on the drug was mostly funded by the U.S. government.[9] Unimed Pharmaceuticals was acquired by Solvay Pharmaceuticals in 1999.[122]
Syndros
Syndros is a liquid oral formulation of dronabinol approved for treatment of chemotherapy-induced nausea / vomiting and AIDS-related weight loss (as with Marinol). Syndros received FDA approval in July 2016,[123] and was assigned a Schedule II classification by the DEA in March 2017.[124] Syndros is manufactured by Insys Therapeutics, which received attention in 2016 for contributing heavily to the defeat of a cannabis legalization initiative in Arizona, in an apparent attempt to protect market share for their product.[125][126] Syndros is expected to launch on the U.S. market in August 2017.[127]
Nabilone
Nabilone is a synthetic cannabinoid similar in molecular structure to THC.[128] It is sold in pill form only as the drug Cesamet.
Cesamet
Cesamet received FDA approval in 1985 for treatment of chemotherapy-induced nausea and vomiting.[129] It was discontinued by its manufacturer Eli Lilly in 1989 for commercial reasons, and U.S. rights to the drug were sold to Valeant Pharmaceuticals in 2004.[129] In 2006, Valeant received FDA approval to resume sales of the drug.[129] Cesamet has remained a Schedule II drug since it was first introduced on the market.[20]
Cannabidiol
Cannabidiol (CBD) is a non-psychoactive component of cannabis known for its anticonvulsant, anti-inflammatory, and anti-anxiety effects, among other medical uses.[130][131] The FDA has not approved cannabidiol for any use however, and the DEA considers cannabidiol to be a Schedule I drug.[132] Despite the Schedule I classification, a number of online retailers sell CBD products to all 50 states, claiming their products are legal because they are derived from the stalks and seeds of industrial hemp plants.[133] The federal government has yet to crack down on these retailers.
Effects of legalizing medical cannabis
A 2016 study found that state medical cannabis laws are associated with significant drops in violent crime.[134] A 2017 study similarly found that introduction of medical cannabis laws caused a reduction in violent crime in American states that border Mexico.[135]
A 2013 study found that medical cannabis legalization is associated with an 8-11% reduction in traffic fatalities.[136]
Several studies have found decreased rates of opioid use / abuse in states that have legalized cannabis for medical purposes.[137][138][139][140][141]
Several studies have found no increase in cannabis use among teens in states that have legalized for medical purposes.[142][143][144][145][146][147][148]
Qualifying conditions
Below is a comparison of common qualifying conditions that will allow a patient to receive medical cannabis in each state. The table is not comprehensive and could include out-of-date information. Low-THC / high-CBD states are not listed.
^"Democracy Held Hostage". ACLU. December 31, 2000. Archived from the original on January 14, 2006. Retrieved April 26, 2017. ((cite news)): Unknown parameter |dead-url= ignored (|url-status= suggested) (help)
^Mark Anderson, D.; Hansen, Benjamin; Rees, Daniel I. (May 2013). "Medical Marijuana Laws, Traffic Fatalities, and Alcohol Consumption". The Journal of Law and Economics. 56 (2): 333–369. doi:10.1086/668812.
